Skip to main content Accessibility help
×
×
Home

Can pharmacology help enhance human morality?

  • Sean A. Spence (a1)

Summary

A responsible person, a moral agent, takes account of their future behaviour and its likely impact upon others. Such an agent may choose to influence their future by exogenous means. If so, might pharmacology help them to do this? Is it doing so already? I argue that it is.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Can pharmacology help enhance human morality?
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Can pharmacology help enhance human morality?
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Can pharmacology help enhance human morality?
      Available formats
      ×

Copyright

References

Hide All
1 Ethics Department. Boosting Your Brainpower: Ethical Aspects of Cognitive Enhancement. British Medical Association, 2007.
2 Harris, J. Enhancing Evolution. The Ethical Case for Making Better People. Princeton University Press, 2007.
3 Glover, J. Humanity: A Moral History of the Twentieth Century. Pimlico, 2001.
4 Mitchell, EW. Madness and meta-responsibility: the culpable causation of mental disorder and the insanity defence. J Forensic Psychiatr 1999; 10: 597622.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Can pharmacology help enhance human morality?

  • Sean A. Spence (a1)
Submit a response

eLetters

Reflexive responses

Sean A Spence, Professor of General Adult Psychiatry
10 November 2008

I am most grateful for the opportunity to respond to the e-letters submitted by Drs Gunathilake, Singh, Al-Adwani, Kuruppuarachchi and Cohen.

As stated in the original article my purpose in writing an editorial had been to attempt to open up a space for discussion with respect to thisone area of pharmacology, especially in light of recent (cited) developments in human pharmacological enhancement, with respect to cognitive function (intelligence). As noted in my original piece, merely raising the issue of pharmacology and morality may be predicted to precipitate reflexive responses. We have not been disappointed.

I should say at the outset that I have nothing against the religious/philosophical models and insights offered by Drs Gunathilake andKuruppuarachchi. My point was to address pharmacology rather than psychology, albeit in the context of a particular clinical situation: one in which one is often dealing with people who have been raised without thebenefit of religious (or even pro-social) instruction, and where historiesof violence, head injury, alcohol and substance misuse lead to the patients concerned not being considered suitable for assessment, let alonetreatment, by psychological (psychotherapeutic) services. There are a great many antisocial men who would fall into this category and their riskto themselves and to others may be considerable.

To suggest that psychiatry does not inevitably impinge upon morality (Singh) may be regarded as disingenuous while we continue to use diagnostic criteria that specifically target rule-breaking, transgression,lying, cheating, conning others etc (are these morally neutral behaviours?); to liken the use of a drug to reduce impulsivity to the communal use of stimulants or hallucinogens (Al-Adwani) is to fundamentally fail to engage with the matter.

If we choose to require our community psychiatric services to attemptto assist and manage people with antisocial behaviours (rather than ignorethem, decline referrals, or 'lose' them to follow up) then I think psychiatry may well be required to 'think outside the box'. That was all that was behind my initial editorial; that and the obvious point that someresponsible clinicians do attempt to help antisocial people to help themselves, through means including (but not confined to) medication.

Of course there will continue to be those for whom any pharmacological intervention in psychiatry is somehow objectionable (Cohen), for whom the political stance against biological treatment is afforded greater significance than individual human recovery from psychosis (which, let's face it, happens on a regular basis in clinical psychiatry). The Cohen thesis is admirably illustrated in a recent book byEugene Richards ('A procession of them', published by University of Texas Press). There are sadly many places in the world where people suffering from psychiatric disorders do not have access to medical treatment. Their plight is far from trivial.
... More

Conflict of interest: None Declared

Write a reply

Prescribers'�not patients'�morality

David Cohen, Professor of Social Work
31 October 2008

Sean A. Spence's thesis appears to rest on a single sentence in his article: "... no matter what the technical means deployed, whether the intervention assists in 'moral enhancement' or not, depends crucially upon the goals of

the patient concerned, i.e. what are the 'ends' that he is pursuing?" (p. 179). This appears so obvious in the case of any tool or behavior—think of paper

clips, making cheese sandwiches, or using a hammer—that Spence's argument appears quite trivial, even pretentious.

Less trivial, however, are specific moral issues unmentioned by the author. In two of the case studies, it seems obvious that the patients do not desire to take drugs. Is there morality in imposing drugs on them? And whose ends are being served by the patients taking the drugs?

More generally, patients who do desire drugs do not simply take them.An intermediary, in this case, the physician, must prescribe them legally. I find it intriguing that Spence does not mention, much less discuss, that in modern

psychopharmacology, drugs are 'deployed' (Spence's expression) by doctors and drug companies, whereas patients mostly adapt to drugs' consequences. It is the 'ends' of these intermediaries—or even the necessity of a medical intermediary between the patient and his drug—that need more moral, ethical, and political elucidation.
... More

Conflict of interest: None Declared

Write a reply

Change is how you use it

Andrew Al-Adwani, Consultant psychiatrist
25 October 2008

Maybe I am missing something but what is new in the proposition Spence has outlined1. When a Yanomani tribesman snorts a powerful concoction of hallucinogens he does so as part of a ritual that includes the shamanistic

healing of others in the tribe and maintaining tribal cohesion through tradition. When a footballer plays on despite injury, with pain relieved by analgesia, he does this in part for his team and fans. When a Peruvian highlander chews coca leaves so that he can work longer hours he does so to keep his family fed; and the same applies to the kratom user in the Far East. When millions of soldiers took amphetamines to enable them to fight for longer hours, thereby exposing themselves to ever greater dangers, they did so to win what they believed to be just wars. When a mother solicits fertility treatment so as to produce a child that will not only add to the family, but also potentially save the life of another sibling, the use of these potentially dangerous drugs is largely driven by the mother's need to save the other child. When groups of men gather every afternoon in the Yemen and chew Qat, this is a social activity enhanced by the use of Qat. In the Middle East coffee shops have always served this purpose, providing socially stimulating conversation, and do so in Europe to this day. Tobacco has had a similar use in many countries and alcohol has done much the same, despite the harm associated with the use of both of these substances. Psychiatrists, on a small scale, have started to use what some term empathogens (i.e. MDMA) so that they can better understand and help their patients (although the less charitable question their motives).

I think we would be splitting hairs to argue that taking a drug to achieve a moral end is fundamentally different from achieving a moral end through use of a drug; they exist on a continuum. Drugs simply allow us to explore and

alter our behaviour and thoughts, how we use this allowance is up to us.

1 Can pharmacology help enhance human morality? The British Journal of Psychiatry 2008; 193: 179-180
... More

Conflict of interest: None Declared

Write a reply

Religion and human morality

Prof K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Professor of Psychiatry
25 October 2008

The article on “ Can pharmacology help enhance human morality “ by Sean A. Spence(2008) has been read with much concern as this area has a global relevance.Even in developing countries such as Sri Lanka more and more people seek help from psychiatrists for conditions like poor impulse control, negativeemotions such as jealousy and poor interpersonal relationships etc. in addition to other psychiatric ailments. The other important aspect note worthy is many clinicians do not talk about personality disorders in countries like Sri Lanka compared with the west. The reasons may be our people may be tolerating aberrant behaviouralpatterns more often than in the west, the actual prevalence may be less orthe presentation of personality disorders may be different. The other contributory factors may be protective family atmosphere and religious upbringing of children for example in Sri Lanka children are expected to attend the religious classes conducted in the Buddhist temples on Sundays.The state is encouraging this. Great work like the Bhagavadgita in India has emphasized the importance of character development even in ancient times. The relevance of Buddhist teaching to the practice of counselling has been highlighted(de Silva, 1993).Obviously many religions encourage moral and spiritual development. Similar upbringing can help the individual to learn to control the impulses, postpone the gratifications and to be altruistic. On the other hand when the person is suffering from other psychiatric illnesses such as depressive disorder he/she will behavedifferently and may exhibit moral difficulties like anger and poor impulsecontrol. Some may seek help from non psychiatrists for similar conditions particularly in developing countries.We believe it is worthwhile paying attention to this important area as more and more people all over the world seek psychiatric help for moral difficulties and expect a quick response in the form of pharmacological interventions. Many people seem to be reluctant to engage in time consuming psychotherapeutic interventions and strenuous spiritual programmes even though their benefits are long lasting. Positive outcomes of incorporating spiritually augmented psychotherapies such as spirituallyaugmented cognitive behaviour therapy in psychiatric practice have been shown(D’Souza & Rodrigo,2004 ). The importance of improving the awareness and the knowledge amongst the psychiatrists of the implications of religious practices and psychiatry has been highlighted(Koenig, 2008). Important drawback in psychiatry is neglecting methods to improve positiveemotions, character development, spirituality and life satisfaction and paying more attention to stigmatizing aspects of mental illness (Cloninger, 2006).Obviously moral development has a preventive role in human behavioural problems such as violence, personality difficulties etc. and clinicians should be able to balance the strike between psychological approaches and pharmacological interventions when they encounter similar situations.

References;Spence, S.A.(2008) Can pharmacology help enhance human morality? British Journal of Psychiatry 193: 179-180.De Silva, P. (1993) Buddhism and Counselling , British Journal of Guidance& Counselling, 21;1,30-34.D’Souza, R.F. & Rodrigo, A. (2004) Spiritually augmented cognitive behavioural therapy, Australasian Psychiatry, 12;2: 148-152.Koenig, H.G.(2008) Religion and mental health: what should psychiatrists do? Psychiatric Bulletin, 32 , 201-203. Cloninger, C.R.(2006) The science of well-being : an integrated approach to mental health and its disorders. World Psychiatry, 5;2: 71-76.
... More

Conflict of interest: None Declared

Write a reply

Re: Psychological methods of enhancing human morality?

Shubh M Singh, Psychiatrist
23 September 2008

Sir,Prof Sean A Spence argues that pharmacology may help enhance human morality and is already doing so (1). Morality as a term can be understoodat the very least as a code of conduct that is acceptable to society and accepted by rational persons(2). Does a psychiatrist have a role in enhancing ‘morality’ of a person? I think that this issue raises many important questions. Firstly, is ‘immorality’ a mental disorder? The ICD-10 for instance defines disorder as a clinically recognizable set of symptoms or behaviour associated with distress and interference in personal functions, social deviance without personal dysfunction is excluded from this definition (3). By that measure immorality, or the state of being at deviance from the norms of morality should not, in most cases qualify as a mental disorder. Does a psychiatrist need to be concerned with an entity that is not a disorder has been debated since long. This is because the validity of the existence of mental disorders has been questioned most often as being a moral, ethical and legal rather than a factual construct (4). Therefore, the question of the ‘boundaries’of psychiatric enquiry and intervention becomes important. It has been pointed out before that the definition of the end of pathology and beginning of morality (where ‘mad’ becomes ‘bad’) is particularly important (5, 6). Slater and Roth for instance point to the danger of unwarranted expansions of the scope of psychiatry once it is divorced fromthe medical scientific view (5). This is because given the present constraints of the lack of knowledge regarding the etiological basis of most mental disorders; psychiatry has to grow within a framework of the biopsychosocial model to retain its legitimacy. The issue of morality alsogives rise to some questions. Is a criminal mentally ill because of immorality, and does a criminal deserve treatment or punishment. If we do find a way to enhance morality, then do we make everyone uniformly ideal and moral or is there scope for diversity among individuals. Lastly is thequestion of preventive and promotive aspects of mental health services. Dopreventive measures in mental health services include prevention of mentaldisorders or immorality? The author makes a case for the use of pharmacology in the improvement of human behaviour. I believe it is very important that such interventions be used in proper context. Pharmacology or indeed any psychiatric intervention as a means to improve ‘immoral’ behaviour should only be used when such behaviour arises from a psychiatric disorder and not otherwise.

1.Spence S. Can pharmacology help enhance human morality? Br J Psychiatry 2008;193:179-80.2.Gert B. The Definition of Morality. The Stanford Encyclopedia of Philosophy 2008 [cited 23 September, 2008]; Available from:

3.World Health Organization. International Classification of Diseases, 10th Revision (ICD-10). Geneva: Switzerland; 1992.4.Szasz T. The myth of mental illness. Am Psychol. 1960;15:113-8.5.Slater E, Roth M. In: Mayer-Gross W, Slater E, Roth M, editor. ClinicalPsychiatry (3rd edn). London: Balliere Tindall and Cassell; 1969. p. xiv-xv.6.Kendell R. The concept of disease. Br J Psychiatry. 1975;127:305-15.
... More

Conflict of interest: None Declared

Write a reply

Psychological methods of enhancing human morality?

Matheesha Gunathilake, Staff Grade Psychiatrist,
03 September 2008



Prof. Sean A. Spence, argues that Pharmacology is being used to enhance human morality (1) , in certain specific instances. He aptly points out the example of a man who asks for antipsychotics to reduce impulsive behaviour which could lead to harm to others.

While the use of pharmacology is a novel modality of reaching a greater degree of moral behaviour, the use of non-pharmacological methods, specifically psychological methods, have been in existence for many a millennia.

Mindfulness is a psychological method of being alert and aware, in the present moment, of all stimuli from the sense organs and the mind. This is increasingly used since its introduction in the form of Mindfulness Based Cognitive Therapy (MBCT) (2) to treat recurrent depression by Teasdale et al. However traditionally, this has been used by Buddhists, in one of it’s uses, to be fully aware of the immoral deeds one might commit. While this, at the outset, may not seem particularly helpful, it forces the (im)moral agent to accept that one has performed an immoral act (often repressed or logically explained away) and to be aware of the feelings which accompany it. It also helps to be fully open to the effects of one’s actions on the other person. When a person is fully open to immoral acts he might commit, it becomes difficult to repeatedly perform such acts. The practice of Mindfulness has had interesting outcomes when performed in prison populations worldwide (3).

Another psychological method is concentration practice where one remains focused on one object -the breath, or a candle for example. This creates a one-pointed or concentrated mind. This ‘one-pointedness’ (samadhi) creates a state of mind which is calm and collected. Negative and destructive emotions are often agitations of the mind, which are the antithesis of this. Practitioners find that the more practice one does, the effects are felt throughout the day. It works possibly by affecting the amygdala, in reducing the arising of negative emotions. It has proven benefits on anxiety in much the same way (4).

(1) Can pharmacology help enhance human morality? Sean A. Spence, The British Journal of Psychiatry (2008) 193: 179-180. doi: 10.1192/bjp.bp.108.052316

(2) Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. J Consult Clin Psychol. 2000 Aug;68(4):615-23.

(3) http://www.prison.dhamma.org/

(4) Relaxation training for anxiety: a ten-years systematic review with meta-analysis. Manzoni GM, Pagnini F, Castelnuovo G, Molinari E. BMC Psychiatry. 2008 Jun 2;8:41.

Declaration of interests: none

Dr.Matheesha GunathilakeTamworth Road Resource Centre37 Tamworth Roach Resource CentreCroydon CRO 1XTwork: 02032280300mobile: 07906357040
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *